Goal-directed decision support system for treating perioperative fluid deficits Gastro-intestinal, cardiac and orthopedic surgeries can result in significant blood and fluid losses. Inappropriate replacement of perioperative fluid losses leads to complications, which increase hospital length and almost double the cost of care. Goal-directed fluid therapy (GDFT) is an evidence-based, proven method of optimizing fluid therapy and improving clinical outcomes. Unfortunately, multiple surveys of anesthesiologists and peer reviewed publications indicate that GDFT is not widely practiced and is not considered the current standard of care. We are developing a decision support software-hardware system for GDFT that provides anesthesiologists and CRNAs an intuitive tool to optimize fluid therapy using proven algorithms. We hypothesize that our algorithmic decision support system will provide greater precision in managing perioperative fluid losses and enhance clinical workflow. This approach has high potential for improving surgical care and post-surgical recovery as well as reducing medical costs. The use of an algorithmic decision support system is fundamentally different from the U.S. standard of care, which remains largely based on intuition and eyeballing vital signs. The project has two aims: 1) develop an integrated Goal-Directed Decision Support System (GDDSS) for treating perioperative fluid deficits and 2) assess usability and workflow of the GDDSS. The integrated system will connect an operating room vital signs monitor and a cardiac output monitor with a bedside tablet computer. The tablet computer will generate real-time recommendations and will trend graphics that overlay physiological variables with fluid therapy, thereby providing a unique and intuitive visual aid for the caregiver to rapidly assess the effectiveness of fluid therapy. We will conduct a human factors study with anesthesiologists, residents and nurse anesthetists during a simulated high risk GI surgery case.